| Objective Benign prostatic hyperplasia (BPH) is a common disease in elderly men. Transurethral resection of the prostate (TURP) treatment of BPH is currently considered the "Gold Standard", but it also has some limitations. Bipolar transurethral plasma kinetic prostatectomy (TUPKP) was widely used in surgery of BPH as the substitute of routine TURP. As the development of laser technology, laser provided a new option for treatment of BPH.2 micron laser vaporesection of prostate is the newest minimally-invasive procedure for BPH. We accessed short-term efficacy of 2 micron laser in treatment of BPH and compared to that of TURPK to evaluate the efficacy, safety and its effect on sexual function.Methods A total of 98 patients who were diagnosed with BPH from April 2009 to December 2009 in Guizhou Province People's Hospital were divided into two groups randomly,50 cases of them underwent two micron laser vaporization resection and 48 cases for TUPKP. All cases were operated by surgeons who are skilled with two micron laser vaporization resection and TUPKP to minimize the differences caused by operator factor. The significant markers therapeutic results were recorded and analyzed, which includes such as international prostatic syndrome score(IPSS), quality of life index (QOL), maximum urinary flow rate (Qmax), post-voiding residual urine volume(PVR), operative time, blood loss, bladder irrigation time, catheterization time, postoperation hospital stays, complications and sexual function. Sex function include sexual life, erectile function, ejaculatory function, before and 3 months after surgical therapy. Data were analyzed statistically to compare the short-term therapeutic effects between the two groups.Results1. There was no significant difference of preoperative factors and the weights of prostates between the two groups (P＞0.05).2. The differences were significant between the two groups (P＜0.01). The mean time of operation for TUPKP was (69.5±17.8)min, shorter than that for two micron laser vaporesection, (80.2±16.9) min. The mean volume of irrigating fluid'during operation for TUPKP was (21.4±4.1)L, less than that for two micron laser vaporesection, (27.1±4.2)L. The blood loss in operation for two micron laser vaporesection was (50.4±13.0)ml, less than that for TUPKP, (87.5±20.4)ml. No blood transfusion was needed and no TURS occurred in both groups.3. The time of bladder irrigating after operation was (15.5±7.5)h in two micron laser group, shorter than the (46.4±9.4)h in TUPKP group. The time of catheterization was (2.4±0.3)d in two micron laser group, shorter than the (4.4±0.8)d in TUPKP group. Hospital stay after surgical therapy was (5.0±0.7)d in two micron laser group, shorter than the (7.1±0.7)d in TUPKP group. Significant difference was found between the two groups in the above three markers (P＜0.05).4. All the cases were followed up for 3 months, IPSS was (5.7±2.0) in two micron laser group, (5.9±2.4) in TUPKP group. QOL was (1.3±0.8) in two micron laser group, (1.6±0.9) in TUPKP group. Qmax was (18.4±1.9) in two micron laser group, (18.4±2.1) in TUPKP group. PVR was (22.3±9.9) in two micron laser group, (20.6±8.4) in TUPKP group. All the markers were improved significantly compared with that of preoperative in both groups (P＜0.001), but there was no significant difference between the two groups (P ＞0.05).5. The complications of 2 micron laser group included 15 cases of urinary irritating syndrome,4 Secondary hemorrhage,6 temporary difficulty of urination,2 urethral stricture and 3 urinary tract infection, and in TUPKP group, the data were 12,3,7,2 and 4 without significant difference. During follow-up of 3 months, no TUR syndrome, blood transfusion, mortality and secondary were needed and no incontinence or acute epididymitis occurred.6. At the end of 3 months follow-up,28 patients showed retrograde ejaculation and 8 patients had improved morning erection, while in the TURPK group it was 26 and 7 respectively with no significant difference between two groups. In 2 micron laser group,5 patients had decreased erection function and 2 patients had improved erectile function, while in TURPK group 4 patients had decreased erectile function and 2 patients had improved erectile function. There was no significant difference in change of pre-and-postoperative erectile function, and between 2 micron laser group and TURPK group.Conclusions1. The two micron laser vaporesection of prostate can significantly improve the patients' lower urinary tract symptoms, and has the same early efficacy as well as TUPKP.2. Compared to TUPKP, two micron laser vaporesection of prostate has more advantages of simpler operation, less blood loss, shorter postoperative catheter indwelling time and hospital stay, rapid recovery after surgery. Two micron laser vaporesection of the prostate is a safe minimally invasive treatment for BPH.3. Both two micron laser vaporesection of prostate and TUPKP can make the statistic difference on retrograde ejaculation and nocturnal penile tumescence.
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